Scoring sheet for medical assessment (reproduced with permission from Professor Janet Treasure)
| System | Test/investigation | Yellow alert | Red alert |
|---|---|---|---|
| Nutrition | Body mass index | <2nd centile | |
| Weight loss/week | >0.5 kg | >1.0 kg | |
| Skin breakdown | <0.1 cm | 0.2 cm | |
| Purpuric rash | Present | ||
| Circulation | Systolic BP | <90 mmHg | <80 mmHg |
| Diastolic BP | <70 mmHg | <60 mmHg | |
| Postural drop | >10 mmHg | >20 mmHg | |
| Pulse rate | <50/min | <40/min | |
| Musculoskeletal | Unable to get up without using arms as balance | Yes | |
| Unable to get up without using arms as leverage | Yes | ||
| Unable to sit up without using arms as leverage | Yes | ||
| Unable to sit up at all | Yes | ||
| Temperature | <35°C (98.0°F) | <34.5°C (97.0°F) | |
| FBC (looking for bone marrow depression) | WCC | <4.0 x 109/l | <2.0 x 109/l |
| Neutrophils | <1.5 x 109/l | <1.0 x 109/l | |
| Hb | <11.0 g/dl | <9.0 g/dl | |
| Acute Hb drop | Yes | ||
| Platelets | <130 x 109/l | <110 x 109/l | |
| Electrolytes | Potassium | <3.5 mmol/l | <3.0 mmol/l |
| Sodium | <135 mmol/l | <130 mmol/l | |
| Magnesium | 0.5–0.7 mmol/l | <0.5 mmol/l | |
| Phosphate | 0.5–0.8 mmol/l | <0.5 mmol/l | |
| Urea | >7 mmol/l | >10 mmol/l | |
| Liver function | Bilirubin | 20–40 μmol/l | >40 μmol/l |
| Alk Phos * | 110–200 U/l | >200 U/l | |
| AST | 40–80 IU/l | >80 IU/l | |
| ALT | 45–90 U/l | >90 U/l | |
| GGT | 45–90 U/l | >90 U/l | |
| Albumin | <35 g/l | <32 g/l | |
| CK | >170 ng/ml | >250 ng/ml | |
| Glucose | <3.5 mmol/l | <2.5 mmol/l | |
| ECG | Pulse rate | <50 | <40 |
| QTc | >450 ms | ||
| Arrhythmia | Present |
↵* Range for infant to 16 years old, 60–425 U/l.5
ALT, alanine aminotransferase; AST, aspartate transaminase; BP, blood pressure; CK, creatine kinase; ECG, electrocardiogram; FBC, full blood count; GGT, gamma-glutaryl transferase; Hb, haemoglobin; QTc, corrected QT interval on ECG; WCC, white cell count.